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Operations Issues zCommunication (dis)connections yInternal and external xDifficulty obtaining information from specialists and hospitals zMedical records risks zPractices generally do not use two identifiers on all patient-related materials (paper charts) zSample medication storage is variable and logs for sample distribution are rarely used

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HIT Issues zEven EHR-enabled practices still use paper zEHR work-arounds abound ze-Rx implementation issues zRegistries: Most practices (paper & EHR) are not able to aggregate data by condition for use in clinical quality improvement zLab interfaces are difficult to establish for many practices zScanning documents is often not as helpful as initially thought

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Summary of CPI Observations zEffective practices have well-trained and empowered non-clinician leader zInformation, idea and training gaps zMulti-tasking is taken to a new art form zHealth IT not the panacea most hope it would be yPractices havent maximized the use of paper zPractices are generally motivated and interested, but challenged to find time to fix the issues that are stealing their time www.fivelaws.demon.co.uk/vicious_circle.jpg

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EHR - Poka-yoke zPoka-yoke - pronounced "POH-kah YOH-keh" means "fail-safing" or "mistake-proofing" avoiding (yokeru) inadvertent errors (poka)) is a behavior-shaping constraint, or a method of preventing errors by putting limits on how an operation can be performed in order to force the correct completion of the operation. The concept was originated by Shigeo Shingo as part of the Toyota Production System. Originally described as Baka-yoke, but as this means "fool- proofing" (or "idiot proofing") the name was changed to the milder Poka-yoke. One example is the inability to remove a car key from the ignition switch of an automobile if the automatic transmission is not first put in the "Park" position, so that the driver cannot leave the car in an unsafe parking condition where the wheels are not locked against movement.behavior-shaping constraint errorsShigeo ShingoToyota Production System http://en.wikipedia.org/wiki/Poka-yoke